How Do Treatment Completers Fare Versus Dropouts?: A Follow-Up Study

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Premature termination from psychotherapy has been reported as the most pressing health care delivery problem of community mental health outpatient clinics since the 1970’s (Albers & Scrivner, 1977). Historically, dropout has been viewed as a negative outcome for all involved, and the research has concentrated on determining what client factor(s) may influence premature termination. However, a study conducted in part by this author (see Krishnamurthy et al., unpublished manuscript) provided preliminary evidence that clients prematurely terminated from treatment after an initial lessening of their symptoms. These preliminary findings oppose the previously held idea that premature termination is predominantly due to a lack of perceived improvement or some dissatisfaction in the therapy process. The current study attempted further exploration of those that prematurely dropped out of treatment to show whether they maintained their gains as compared to those that completed the prescribed treatment protocol. Although underpowered, it was found that individuals who drop out of treatment, contrary to Eysenck’s (1952) theory, are not all treatment failures. In the present study, it was found that similar to completers, those who dropped out of treatment comprised groups that both did (44%) and did not (34%) obtain high rates of improvement. In fact, the subset of dropouts who achieved the stringent criteria of clinically significant change (CSC) in eight or fewer sessions made as much gain as those who completed the study. These individuals were also found to maintain these gains over time, equal to those who received the full dose of treatment. The approach of managed healthcare regarding psychological services, where there are often strict preset limits for the number and cost of services that are covered (DeLeon, Vandenbos, & Bulatao, 1991), may need to be better informed and become more flexible following this model of change. A one-size-fits-all approach to length of treatment may not be appropriate, as some individuals “get it” faster than others do.